Education And Debate

With nurse practitioners, who needs house officers?

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7000.309 (Published 29 July 1995) Cite this as: BMJ 1995;311:309
  1. Sue Dowling, consultant senior lecturera,
  2. Sue Barrett, reader in policy and organisation studiesb,
  3. Richard West, postgraduate deanc
  1. aDepartment of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. bCentre for Social Management School for Advanced Urban Studies, University of Bristol
  3. cDepartment of Postgraduate Medical Education, University of Bristol, Frenchay Hospital, Bristol BS16 1LE
  1. Correspondence to: Dr Dowling.
  • Accepted 9 May 1995

The boundaries between the work of doctors and that of nurses are changing, with nurses taking over important parts of junior hospital doctor's clinical work. In 1993 an exploratory study was carried out to identify the professional, educational, and management issues that such developments raise. Interviews were carried out with a range of stakeholders in three innovatory posts in which nurses were doing much of the clinical work of house officers. A complex picture of perceived benefits and problems for patients, junior doctors, and nurses emerged. These seemed to be associated with (a) the extent to which the contribution of professional nursing was valued in the new role and (b) the amount of clinical discretion which the postholder was allowed, this depending on the type of preparatory education provided and the management of the post. The study points to the need for strategic issues—such as the development of appropriate education and the professional recognition of these new clinical roles—to be addressed at a national and regional level.

The boundaries between the clinical work of doctors and that of nurses in the acute sector are being redrawn owing to a complex mixture of pressures coming from new technologies and treatments, changing patterns of health care delivery, and the processes by which services are purchased and provided. To doctors, perhaps the most obvious pressures are the requirements of the “new deal” to reduce junior's hours,*REF 1* and the Calman report's recommendations to shorten specialist training.*REF 2* Both will reduce the availability of juniors for service work, making nurse substitution an option to be considered. In July 1992 the United Kingdom Central Council for Nursing, Midwifery and Health Visiting published new statutory regulations*REF 3* intended to liberate professional nursing practice from previous rules that had limited the activities they could undertake outside basic …

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